Healthcare Provider Details

I. General information

NPI: 1881666790
Provider Name (Legal Business Name): JAMES CAROL THOMPSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N CHARLES RICHARD BEALL BLVD
DEBARY FL
32713-2271
US

IV. Provider business mailing address

190 N CHARLES RICHARD BEALL BLVD
DEBARY FL
32713-2271
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-7670
  • Fax: 386-668-8604
Mailing address:
  • Phone: 386-917-7670
  • Fax: 386-668-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9701174
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 114276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: